'As the NHS comes under greater and more sustained pressure, figures released from NHS Improvement today reflect the extraordinary efforts of NHS staff to provide care in challenging circumstances. But as pressure on services continues to build, we are seeing falling performance against targets.

‘Emergency departments continue to see rising demand, but the even steeper rise in patients requiring admission also places significant pressure on hospitals. These patients are likely to have more complex needs than ever before. Recent Health Foundation analysis showed that in 2015/16 one in three emergency patients admitted for an overnight stay had five or more health conditions, up from one in ten in 2006/7.

‘Reductions in the number of delayed discharges from hospital are encouraging, particularly ahead of what is certain to be a challenging winter for the NHS. But on its own, this will not offset pressures elsewhere in the system – this includes the impact of more seriously unwell patients who need hospital admission. It underlines the urgent need for additional investment in services outside hospital, including general practice, community nursing, and social care. Without thriving services in the community, patients cannot be supported after discharge, and it is much harder to prevent admissions.

‘As more patients wait longer for urgent and non-urgent treatment, it will be essential that the quality of care does not deteriorate, and lead to worse outcomes. With the NHS under unprecedented strain, robustly monitoring the quality of the care it delivers is vital. This must extend beyond the traditional headline figures of emergency department performances and include areas which are less visible but no less important, such as patient experience. For the NHS, a robust 10 year plan and additional investment cannot come too soon.’